抗癌治疗被认为是肿瘤相关血栓患者在抗凝治疗过程中出现急性出血的独立危险因素。当靶向血管内皮生长因子受体的酪氨酸激酶抑制剂（VEGFR-TKI）与抗凝剂同时使用时，这种出血风险增加被视为一个重大关注点。我们通过对Caravaggio研究中诊断为静脉血栓栓塞症的癌症患者进行亚分析，评估了联合使用VEGF-TKI和口服直接抗凝剂（阿比昔班）或低分子肝素达尔地那对患者的影响。在接受任何形式抗癌治疗的668名患者中，大出血的发生率为4.2%，在未接受任何抗癌治疗的487名患者中，大出血的发生率为3.5%。相对风险值为1.58 (95% CI: 0.69-3.68)，与接受VEGF-TKI以外抗癌剂物治疗的患者相比，以及相对风险值为1.73 (95% CI: 0.73-4.07)，与未接受任何抗癌治疗的患者相比。VEGF-TKI的使用对静脉血栓栓塞症的复发率没有影响。在同时给予VEGF-TKI和抗凝治疗的患者中观察到在大出血事件方面的数值上略有增加，但并无统计学显著性差异，而使用阿比昔班的患者并无过量出血。需要进一步进行前瞻性、设计良好的研究，以评估VGEF-TKI与抗凝剂联合使用是否会导致接受静脉血栓栓塞症治疗的癌症患者出血风险的增加。版权所有©2023 Elsevier Inc. 保留所有权利。

Anti-cancer treatment is considered an independent risk factor for emergent bleeding during anticoagulant treatment in patients with cancer-associated thrombosis. This increased bleeding risk is perceived as major concern particularly when tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial derived growth factor receptor (VEGFR-TKIs) are co-administered with anticoagulants. We evaluated the effects of the combined administration of a VEGF-TKI and the oral direct anticoagulant (apixaban) or the low-molecular weight-heparin dalteparin in a sub-analysis of the Caravaggio study in patients with a diagnosis of cancer patients with venous thromboembolism. The rate of major bleeding was 4.2% in the 668 patients who received any type of anti-cancer treatment and 3.5% in the 487 patients who did not receive any anti-cancer treatment. The relative risk for patients treated with a VEGF-TKI was 1.58 (95% CI: 0.69-3.68), compared to patients treated with anticancer agents other than a VEGF-TKI and 1.73 (95% CI: 0.73-4.07) compared to patients who did not receive any anticancer treatment. The administration of a VGEF-TKI did not have any impact on the recurrence rate of venous thromboembolism. We observed a numerically not statistically significant increase in major bleeding events in patients on concurrent VEGF-TKI and therapeutic anticoagulation with no excess in those who received apixaban. Further prospective well-designed studies are needed to evaluate whether the concomitant administration of VGEF-TKI and anticoagulant agents may result in an increase of bleeding in patients with a diagnosis of cancer treated for venous thromboembolism.Copyright © 2023 Elsevier Inc. All rights reserved.